Related Experiment Videos
Activation mapping from the coronary sinus may be limited by anatomic variations
Y Yamanouchi1, O Igawa, I Hisatome
1First Department of Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Japan. yyamanou@grape.med.tottori-u.ac.jp
Insights
The distance between the mitral annulus (MA) and coronary sinus (CS) varies, being longest at the left posterolateral free wall. Understanding this anatomic relationship is crucial for interpreting electrophysiological data during CS mapping.
Area of Science:
- Anatomy
- Cardiovascular Science
- Medical Imaging
Background:
- The mitral annulus (MA) and coronary sinus (CS) are critical structures in cardiac anatomy.
- Accurate knowledge of their spatial relationship is essential for cardiac procedures and research.
Purpose of the Study:
- To investigate the detailed anatomic relationship between the mitral annulus (MA) and the coronary sinus (CS).
- To quantify the distance between the MA and CS at various points around the annulus.
Main Methods:
- Autopsy examination of 50 human hearts (31 male, 19 female).
- Sectioning of the mitral annulus perpendicular to its plane, with radial subdivision of the posterolateral block.
- Measurement of the distance (D) from the ventricular endocardium under the MA to the nearest wall of the CS at specific angular intervals.
Main Results:
- The distance (D) between the MA and CS varied significantly across different sections.
- The longest distances were observed at 72 and 108 degrees, corresponding to the left posterolateral free-wall location.
- A common anatomic pattern ('Type C') showed separation and reapproximation of the annulus and sinus.
Conclusions:
- The anatomic configuration between the MA and CS is not uniform and presents variations.
- The longest MA-CS distance occurs at the left posterolateral free wall, potentially influencing CS mapping.
- Electrophysiological data obtained during CS mapping should be interpreted considering these anatomical findings.
Abstract:
The purpose of this study was to examine the anatomic relationship between the mitral annulus (MA) and the coronary sinus (CS). Fifty consecutive hearts of 31 men and 19 women, 63.5 +/- 13.7 years of age, were examined at autopsy. MA was divided perpendicularly to the annular plane into an anteromedial block and a posterolateral block by sectioning from the CS ostium through the center of MA. The posterolateral block was subdivided radially into five equal sections at 36 degrees, 72 degrees, 108 degrees, 144 degrees, and 180 degrees. The distance from the ventricular endocardium under MA to the nearest wall of CS (D) was measured in each cross-section. D measured 9.7 +/- 2.3, 10.9 +/- 3.3, 10.2 +/- 3.6, 9.2 +/- 3.4, and 8.2 +/- 2.9 mm at 36 degrees, 72 degrees, 108 degrees, 144 degrees, and 180 degrees, respectively. D at 72 was significantly longer than at 144 degrees and 180 degrees (P < 0.01). Likewise, D at 108 degrees was significantly longer than at 144 degrees and 180 degrees (P < 0.05). The population was divided according to the morphology into five patterns. "Type C," the pattern that separated in the middle section and then reapproximated, was more common (66%) than any other pattern. D was confirmed to be longest at the level of the 72 degrees section, corresponding to a left posterolateral free-wall location. The potential mapping in CS would be easily modified by this anatomic feature. When mapping activation from the CS, the electrophysiological data should be interpreted in light of these anatomic findings.